ISSN: 0034-8376
eISSN: 2564-8896






Screening Tool for Restrictive and Obstructive Ventilatory Abnormalities in a Population-Based Survey



Rosario Fernández-Plata, Departments of Epidemiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
Ireri Thirión-Romero, Department of Investigation on Tobacco and Chronic Obstructive Pulmonary Disease, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
David Martínez-Briseño, Epidemiology and Social Science in Health, Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico
Francisco Franco-Marina, Department of Epidemiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
Rogelio Pérez-Padilla, Department of Investigation on Tobacco and Chronic Obstructive Pulmonary Disease, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico


Background: A 6 s spirometry with an inexpensive pocket spirometer efficiently selects individuals for a diagnostic-quality spirometry for airflow limitation, but could also be useful to identify individuals with a restrictive pattern. Objectives: We evaluated an inexpensive simplified spirometer (chronic obstructive pulmonary disease [COPD]-6) as a screening tool to identify spirometric abnormalities. Methods: A population-based survey in Mexico City, with 742 participants performing pre- and post-BD spirometry and a three-maneuver 6 s spirometry (pre-BD) with a COPD-6. We evaluated forced expiratory volume in 1 s (FEV1), FEV6, and FEV1/FEV6 from the COPD-6, crude and expressed as the percentage of predicted (%P), to discriminate post-bronchodilator airflow obstruction (FEV1/forced vital capacity [FVC] <5th percentile) or restriction (FVC or FEV1 <5th percentile with normal FEV1/FVC) through receiver operating characteristics and their area under the curve (AUC). Results: FEV1%P was the best predictor to identify pre- and post-BD ventilatory abnormalities (best cutoff point 87%P, AUC 92% for restrictive pattern, 89% for obstructive pattern, and 91% for any spirometric abnormality). Deriving to clinical spirometry only those with <87%P (26% of the sample) missed only 12% of spirometric abnormalities most of the latter mild. Conclusions: An FEV1 <87%P from a pre-BD 6 s spirometry correctly identified individuals with spirometric ventilatory defects, either obstructive or restrictive.



Keywords: Chronic Obstructive Pulmonary Disease. Restrictive pattern. Forced expiratory volume in 1 s. Screening. Case finding. Spirometry. COPD-6. Population-based survey.